If you experience one of the following symptoms, such as shortness of breath/difficulty breathing, tight feeling in throat, swelling of tongue, dizziness, feeling of loss of consciousness, redness or swelling of face, body rash, nausea and vomiting, you should immediately alert your doctor or nurse (see section 4).

Children and adolescents

Iasibon should not be used in children and adolescents below the age of 18 years.

Other medicines and Iasibon

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This is because Iasibon can affect the way some other medicines work. Also, some other medicines can affect the way Iasibon works.

In particular, tell your doctor or pharmacist if you are receiving a type of antibiotic injection called ‘aminoglycoside’ such as gentamicin. This is because aminoglycosides and Iasibon can both lower the amount of calcium in your blood.

Pregnancy and breast-feeding

Do not receive Iasibon if you are pregnant, planning to get pregnant or if you are breast-feeding. Ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

You can drive and use machines as it’s expected that Iasibon affectshas no or negligible effect on your ability to drive and use machines. Talk to your doctor first if you want to drive, use machines or tools.

3. How to receive Iasibon Receiving this medicine

Iasibon is normally given by a doctor or other medical staff who have experience with the treatment of cancer.

it is given as an infusion into your vein

Your doctor may do regular blood tests while you are receiving Iasibon. This is to check that you are being given the right amount of this medicine.

How much to receive

Your doctor will work out how much Iasibon you will be given depending on your illness.

If you have breast cancer that has spread to your bones, then the recommended dose is 6 ampoules (6 mg) every 3-4 weeks, as an infusion in your vein over at least 15 minutes.

If you have a raised calcium level in your blood due to a tumour then the recommended dose is a single administration of 2 ampoules (2 mg) or 4 ampoules (4 mg), depending on the severity of your illness. The medicine should be administered as an infusion in your vein over two hours. A repeated dose may be considered in case of insufficient response or if your illness reappears.

Your doctor may adjust your dose and duration of intravenous infusion if you have kidney problems.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4.Possible side effects

Like all medicines, this medicine can cause side effects although not everybody gets them.

Talk to a nurse or a doctor straight away if you notice any of the following serious side effects - you may need urgent medical treatment:

Rare (may affect up to 1 in 1,000 people)

persistent eye pain and inflammation

new pain, weakness or discomfort in your thigh, hip or groin. You may have early signs of a possible unusual fracture of the thigh bone.

Very rare (may affect up to 1 in 10,000 people)

pain or sore in your mouth or jaw, You may have early signs of severe jaw problems (necrosis (dead bone tissue) in the jaw bone.

itching, swelling of your face, lips, tongue and throat, with difficulty breathing. You may be having a serious, potentially life threatening allergic reaction (see section 2).

severe adverse skin reactions

ear pain, discharge from the ear, and/or an ear infection. These could be signs of bone damage in the ear.

Not known (frequency cannot be estimated from the available data)

asthma attack

Other possible side effects

Common (may affect up to 1in 10 people)

rise in body temperature.

flu-like symptoms, including fever, shaking and shivering, feeling of discomfort, fatigue, bone pain and aching muscles and joints. These symptoms usually disappear within a couple of hours or days. Talk to a nurse or doctor if any effects become troublesome or last more than a couple of days

stomach and tummy pain, indigestion, being sick vomiting or having diarrhoea (loose bowels)

low calcium or phosphate levels in your blood

changes in blood test results such as Gamma GT or creatinine

a heart rhythm problem called ‘bundle branch block’

pain in your bone or muscles

headache, feeling dizzy or feeling weak

feeling thirsty, sore throat, changes in taste

swollen legs or feet

aching joints, arthritis, or other joint problems

problems with your parathyroid gland

bruising

infections

a problem with your eyes called ‘cataracts’

skin problems

tooth problems.

Uncommon (may affect less than 1 in 100 people)

shaking or shivering

your body temperature getting too low (‘hypothermia’)

a condition affecting the blood vessels in your brain called ‘cerebrovascular disorder’ (stroke or brain bleeding)

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet.You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5.How to store Iasibon

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the folding box and on the label after EXP. The expiry date refers to the last day of that month

After dilution the infusion solution is stable for 24 hours at 2-8 °C (in a refrigerator)

Do not use this medicine if you notice that the solution is not clear or contains particles

6. Content of the pack and other information

What Iasibon contains

The active substance is ibandronic acid. One ampoule with 1 ml of a concentrate for solution for infusion contains 1 mg ibandronic acid (as sodium monohydrate)

The other ingredients are sodium chloride, glacial acetic acid, sodium acetate trihydrate and water for injections

The following information is intended for healthcare professionals only

Dose: Prevention of skeletal events in patients with breast cancer and bone metastases

The recommended dose for prevention of skeletal events in patients with breast cancer and bone metastases is 6 mg intravenously given every 3-4 weeks. The dose should be infused over at least 15 minutes.

Patients with renal impairment

For patients with mild renal impairment (CLcr ≥50 and <80 mL/min) no dosage adjustment is necessary. For patients with moderate renal impairment (CLcr ≥30 and <50 mL/min) or severe renal impairment (CLcr <30 mL/min) being treated for the prevention of skeletal events in patients with breast cancer and metastatic bone disease the following dosing recommendations should be followed:

Creatinine Clearance

Dosage

Infusion Volume 1 and Time 2

(ml/min)

≥50 CLcr <80

6 mg

(6 ml of concentrate for

100 ml over 15 minutes

solution for infusion)

≥30 CLcr <50

4 mg

(4 ml of concentrate for

500 ml over 1 hour

solution for infusion)

<30

2 mg

(2 ml of concentrate for

500 ml over 1 hour

solution for infusion)

10.9% sodium chloride solution or 5% glucose solution

2Administration every 3 to 4 week

A 15 minute infusion time has not been studied in cancer patients with CLCr <50 mL/min.

Dose: Treatment of tumour-induced hypercalcaemia

Iasibon is usually administered in a hospital setting. The dose is determined by the doctor considering the following factors.

Prior to treatment with Iasibon the patient should be adequately rehydrated with 9 mg/ml (0.9%) sodium chloride. Consideration should be given to the severity of the hypercalcaemia as well as the tumour type. In most patients with severe hypercalcaemia (albumin-corrected serum calcium* ≥3 mmol/l or ≥12 mg/dl) 4 mg is an adequate single dosage. In patients with moderate hypercalcaemia (albumin- corrected serum calcium <3 mmol/l or <12 mg/dl) 2 mg is an effective dose. The highest dose used in clinical trials was 6 mg but this dose does not add any further benefit in terms of efficacy.

To convert the albumin-corrected serum calcium in mmol/l value to mg/dl, multiply by 4.

In most cases a raised serum calcium level can be reduced to the normal range within 7 days. The median time to relapse (re-increase of serum albumin-corrected serum calcium above 3 mmol/l) was 18- 19 days for the 2 mg and 4 mg doses. The median time to relapse was 26 days with a dose of 6 mg.

Method and route of administration

Iasibon concentrate for solution for infusion should be administered as an intravenous infusion.

In order to avoid potential incompatibilities Iasibon concentrate for solution for infusion should only be diluted with isotonic sodium chloride solution or 5% dextrose solution. Calcium containing solutions should not be mixed with Iasibon concentrate for solution for infusion.

Diluted solutions are for single use. Only clear solutions without particles should be used.

It is recommended that the product once diluted be used immediately (see point 5 of this leaflet “How to store Iasibon”).

Iasibon concentrate for solution for infusion should be administered as an intravenous infusion.

Care must be taken not to administer Iasibon concentrate for solution for infusion via intra-arterial or paravenous administration, as this could lead to tissue damage..

Frequency of administration

For treatment of tumour induced hypercalcaemia, Iasibon concentrate for solution for infusion is generally given as a single infusion.

For the prevention of skeletal events in patients with breast cancer and bone metastases, the Iasibon infusion is repeated at 3-4 week intervals.

Duration of treatment

A limited number of patients (50 patients) have received a second infusion for hypercalcaemia. Repeated treatment may be considered in case of recurrent hypercalcaemia or insufficient efficacy.

For patients with breast cancer and bone metastases, Iasibon infusion should be administered every 3-4 weeks. In clinical trials, therapy has continued for up to 96 weeks.

Overdose

Up to now there is no experience of acute poisoning with Iasibon concentrate for solution for infusion. Since both the kidney and the liver were found to be target organs for toxicity in preclinical studies with high doses, kidney and liver function should be monitored.

If you experience one of the following symptoms, such as shortness of breath/difficulty breathing, tight feeling in throat, swelling of tongue, dizziness, feeling of loss of consciousness, redness or swelling of face, body rash, nausea and vomiting, you should immediately alert your doctor or nurse (see section 4).

Children and adolescents

Iasibon should not be used in children and adolescents below the age of 18 years.

Othermedicines and Iasibon

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This is because Iasibon can affect the way some other medicines work. Also, some other medicines can affect the way Iasibon works.

In particular, tell your doctor or pharmacist if you are receiving a type of antibiotic injection called ‘aminoglycoside’ such as gentamicin. This is because aminoglycosides and Iasibon can both lower the amount of calcium in your blood.

Pregnancy and breast-feeding

Do not receive Iasibon if you are pregnant, planning to get pregnant or if you are breast-feeding. Ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

You can drive and use machines as it’s expected that Iasibon has no or negligible effect on your ability to drive and use machines. Talk to your doctor first if you want to drive, use machines or tools.

Iasibon is normally given by a doctor or other medical staff who have experience with the treatment of cancer.

it is given as an infusion into your vein

Your doctor may do regular blood tests while you are receiving Iasibon. This is to check that you are being given the right amount of this medicine.

How much to receive

Your doctor will work out how much Iasibon you will be given depending on your illness.

If you have breast cancer that has spread to your bones, then the recommended dose is 3 ampoules (6 mg) every 3-4 weeks, as an infusion in your vein over at least 15 minutes.

If you have a raised calcium level in your blood due to a tumour then the recommended dose is a single administration of 1 ampoule (2 mg) or 2 ampoules (4 mg), depending on the severity of your illness. The medicine should be administered as an infusion in your vein over two hours. A repeated dose may be considered in case of insufficient response or if your illness reappears.

Your doctor may adjust your dose and duration of intravenous infusion if you have kidney problems.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects although not everybody gets them.

Talk to a nurse or a doctor straight away if you notice any of the following serious side effects - you may need urgent medical treatment:

Rare (may affect up to 1 in 1,000 people)

persistent eye pain and inflammation

new pain, weakness or discomfort in your thigh, hip or groin. You may have early signs of a possible unusual fracture of the thigh bone.

Very rare (may affect up to 1 in 10,000 people)

pain or sore in your mouth or jaw You may have early signs of severe jaw problems (necrosis (dead bone tissue) in the jaw bone).

itching, swelling of your face, lips, tongue and throat, with difficulty breathing. You may be having a serious, potentially life threatening allergic reaction (see section 2)

severe adverse skin reactions

ear pain, discharge from the ear, and/or an ear infection. These could be signs of bone damage in the ear.

Not known (frequency cannot be estimated from the available data)

asthma attack

Other possible side effects

Common (may affect up to 1 in 10 people)

flu-like symptoms, including fever, shaking and shivering, feeling of discomfort, fatigue, bone pain and aching muscles and joints. These symptoms usually disappear within a couple of hours or days. Talk to a nurse or doctor if any effects become troublesome or last more than a couple of days

rise in body temperature.

stomach and tummy pain, indigestion, being sick vomiting or having diarrhoea (loose bowels)

low calcium or phosphate levels in your blood

changes in blood test results such as Gamma GT or creatinine

a heart rhythm problem called ‘bundle branch block’

pain in your bone or muscles

headache, feeling dizzy or feeling weak

feeling thirsty, sore throat, changes in taste

swollen legs or feet

aching joints, arthritis, or other joint problems

problems with your parathyroid gland

bruising

infections

a problem with your eyes called ‘cataracts’

skin problems

tooth problems.

Uncommon (may affect less than 1 in 100 people)

shaking or shivering

your body temperature getting too low (‘hypothermia’)

a condition affecting the blood vessels in your brain called ‘cerebrovascular disorder’ (stroke or brain bleeding)

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet.You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Iasibon

Keep this medicine out of the sightand reachof children.

Do not use this medicine after the expiry date which is stated on the folding box and on the label after EXP. The expiry date refers to the last day of that month.

After dilution the infusion solution is stable for 24 hours at 2-8 °C (in a refrigerator).

Do not use this medicine if you notice that the solution is not clear or contains particles.

6. Content of the pack and other information

What Iasibon contains

The active substance is ibandronic acid. One ampoule with 2 ml of a concentrate for solution for infusion contains2 mg ibandronic acid (as sodium monohydrate)

The other ingredients are sodium chloride, glacial acetic acid, sodium acetate trihydrate and water for injections

The following information is intended for healthcare professionals only

Dose: Prevention of skeletal events in patients with breast cancer and bone metastases

The recommended dose for prevention of skeletal events in patients with breast cancer and bone metastases is 6 mg intravenously given every 3-4 weeks. The dose should be infused over at least 15 minutes.

Patients with renal impairment

For patients with mild renal impairment (CLcr ≥50 and <80 mL/min) no dosage adjustment is necessary. For patients with moderate renal impairment (CLcr ≥30 and <50 mL/min) or severe renal impairment (CLcr <30 mL/min) being treated for the prevention of skeletal events in patients with breast cancer and metastatic bone disease the following dosing recommendations should be followed:

Creatinine Clearance

Dosage

Infusion Volume 1 and Time 2

(ml/min)

≥50 CLcr <80

6 mg

(6 ml of concentrate for

100 ml over 15 minutes

solution for infusion)

≥30 CLcr <50

4 mg

(4 ml of concentrate for

500 ml over 1 hour

solution for infusion)

<30

2 mg

(2 ml of concentrate for

500 ml over 1 hour

solution for infusion)

10.9% sodium chloride solution or 5% glucose solution

2Administration every 3 to 4 week

A 15 minute infusion time has not been studied in cancer patients with CLCr <50 mL/min.

Dose: Treatment of tumour-induced hypercalcaemia

Iasibon is usually administered in a hospital setting. The dose is determined by the doctor considering the following factors.

Prior to treatment with Iasibon the patient should be adequately rehydrated with 9 mg/ml (0.9%) sodium chloride. Consideration should be given to the severity of the hypercalcaemia as well as the tumour type. In most patients with severe hypercalcaemia (albumin-corrected serum calcium* ≥3 mmol/l or

≥12 mg/dl) 4 mg is an adequate single dosage. In patients with moderate hypercalcaemia (albumin- corrected serum calcium <3 mmol/l or <12 mg/dl) 2 mg is an effective dose. The highest dose used in clinical trials was 6 mg but this dose does not add any further benefit in terms of efficacy.

To convert the albumin-corrected serum calcium in mmol/l value to mg/dl, multiply by 4.

In most cases a raised serum calcium level can be reduced to the normal range within 7 days. The median time to relapse (re-increase of serum albumin-corrected serum calcium above 3 mmol/l) was 18- 19 days for the 2 mg and 4 mg doses. The median time to relapse was 26 days with a dose of 6 mg.

Method and route of administration

Iasibon concentrate for solution for infusion should be administered as an intravenous infusion.

In order to avoid potential incompatibilities Iasibon concentrate for solution for infusion should only be diluted with isotonic sodium chloride solution or 5% dextrose solution. Calcium containing solutions should not be mixed with Iasibon concentrate for solution for infusion.

Diluted solutions are for single use. Only clear solutions without particles should be used.

It is recommended that the product once diluted be used immediately (see point 5 of this leaflet “How to store Iasibon”).

Iasibon concentrate for solution for infusion should be administered as an intravenous infusion. Care must be taken to e administer Iasibon concentrate for solution for infusion via intra-arterial or paravenous administration, as this could lead to tissue damage.

Frequency of administration

For treatment of tumour induced hypercalcaemia, Iasibon concentrate for solution for infusion is generally given as a single infusion.

For the prevention of skeletal events in patients with breast cancer and bone metastases, the Iasibon infusion is repeated at 3-4 week intervals.

Duration of treatment

A limited number of patients (50 patients) have received a second infusion for hypercalcaemia. Repeated treatment may be considered in case of recurrent hypercalcaemia or insufficient efficacy.

For patients with breast cancer and bone metastases, Iasibon infusion should be administered every 3-4 weeks. In clinical trials, therapy has continued for up to 96 weeks.

Overdose

Up to now there is no experience of acute poisoning with Iasibon concentrate for solution for infusion. Since both the kidney and the liver were found to be target organs for toxicity in preclinical studies with high doses, kidney and liver function should be monitored.

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

Keep this leaflet. You may need to read it again.

If you have any further questions, ask your doctor, pharmacist or nurse

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet:

1.What Iasibon is and what it is used for

2.What you need to know before you receive Iasibon

3.How to receive Iasibon

4.Possible side effects

5.How to store Iasibon

6.Contents of the pack and other information

1. What Iasibon is and what it is used for

Iasibon contains the active substance ibandronic acid. This belongs to a group of medicines called bisphosphonates.

Iasibon is used in adults and prescribed to you if you have breast cancer that has spread to your bones (called ‘bone metastases’)

It helps to prevent your bones from breaking (fractures)

It helps to prevent other bone problems that may need surgery or radiotherapy

Iasibon can also be prescribed if you have a raised calcium level in your blood due to a tumour.

Iasibon works by reducing the amount of calcium that is lost from your bones. This helps to stop your bones from getting weaker.

2. What you need to know before you receive Iasibon

Do not receive Iasibon

if you are allergic to ibandronic acid or any of the other ingredients of this medicine that are listed in section 6

if you have low calcium levels in your blood (hypocalcaemia).

Do not receive this medicine if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before having Iasibon.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before receiving Iasibon:

if you are allergic to any other bisphosphonates

if you have high or low levels of vitamin D, calcium or any other minerals

if you have kidney problems.

If you have heart problems and the doctor recommended to limit your daily fluid intake

If you are having dental treatment or surgery or know that you need some in the future, tell your dentist that you are being treated with Iasibon for cancer

Cases of serious, sometimes fatal allergic reaction have been reported in patients treated with

intravenous ibandronic acid.

If you experience one of the following symptoms, such as shortness of breath/difficulty breathing, tight feeling in throat, swelling of tongue, dizziness, feeling of loss of consciousness, redness or swelling of face, body rash, nausea and vomiting, you should immediately alert your doctor or nurse (see section 4).

Children and adolescents

Iasibon should not be used in children and adolescentsbelow the age of 18 years.

Other medicines and Iasibon

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This is because Iasibon can affect the way some other medicines work. Also, some other medicines can affect the way Iasibon works.

In particular, tell your doctor or pharmacist if you are receiving a type of antibiotic injection called ‘aminoglycoside’ such as gentamicin. This is because aminoglycosides and Iasibon can both lower the amount of calcium in your blood.

Pregnancy and breast-feeding

Do not receive Iasibon if you are pregnant, planning to get pregnant or if you are breast-feeding. Ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines:

You can drive and use machines as it’s expected that Iasibon has no or negligible effect on your ability to drive and use machines. Talk to your doctor first if you want to drive, use machines or tools.

Iasibon is normally given by a doctor or other medical staff who have experience with the treatment of cancer.

It is given as an infusion into your vein

Your doctor may do regular blood tests while you are receiving Iasibon. This is to check that you are being given the right amount of this medicine.

How much to receive

Your doctor will work out how much Iasibon you will be given depending on your illness.

If you have breast cancer that has spread to your bones, then the recommended dose is 1 vial (6 mg) every 3-4 weeks, as an infusion in your vein over at least 15 minutes.

If you have a raised calcium level in your blood due to a tumour, then the recommended dose is a single administration of 2 mg or 4 mg, depending on the severity of your illness. The medicine should be administered as an infusion in your vein over two hours. A repeated dose may be considered in case of insufficient response or if your illness reappears.

Your doctor may adjust your dose and duration of intravenous infusion if you have kidney problems.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Talk to a nurse or a doctor straight away if you notice any of the following serious side effects -

you may need urgent medical treatment:

Rare (may affect up to 1 in 1,000 people)

persistent eye pain and inflammation

new pain, weakness or discomfort in your thigh, hip or groin. You may have early signs of a possible unusual fracture of the thigh bone

Very rare (may affect up to 1 in 10,000 people)

pain or sore in your mouth or jaw. You may have early signs of severe jaw problems (necrosis (dead bone tissue) in the jaw bone).

itching, swelling of your face, lips, tongue and throat, with difficulty breathing. You may be having a serious, potentially life threatening allergic reaction (see section 2)

severe adverse skin reactions

ear pain, discharge from the ear, and/or an ear infection. These could be signs of bone damage in the ear.

Not known (frequency cannot be estimated from the available data)

asthma attack

Other possible side effects

Common (may affect up to 1 in 10 people)

flu-like symptoms, including fever, shaking and shivering, feeling of discomfort, fatigue, bone pain and aching muscles and joints. These symptoms usually disappear within a couple of hours or days. Talk to a nurse or doctor if any effects become troublesome or last more than a couple of days

rise in body temperature.

stomach and tummy pain, indigestion, being sick vomiting or having diarrhoea (loose bowels)

low calcium or phosphate levels in your blood

changes in blood test results such as Gamma GT or creatinine

a heart rhythm problem called ‘bundle branch block’

pain in your bone or muscles

headache, feeling dizzy or feeling weak

feeling thirsty, sore throat, changes in taste

swollen legs or feet

aching joints, arthritis, or other joint problems

problems with your parathyroid gland

bruising

infections

a problem with your eyes called ‘cataracts’

skin problems

tooth problems.

Uncommon (may affect less than 1 in 100 people)

shaking or shivering

your body temperature getting too low (‘hypothermia’)

a condition affecting the blood vessels in your brain called ‘cerebrovascular disorder’ (stroke or brain bleeding)

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Iasibon

Keep this medicine out of the sightand reachof children

Do not use this medicine after the expiry date which is stated on the folding box and on the label after EXP. The expiry date refers to the last day of that month.

After dilution the infusion solution is stable for 24 hours at 2-8 °C (in a refrigerator)

Do not use this medicine if you notice that the solution is not clear or contains particles

6. Content of the pack and other information

What Iasibon contains

The active substance is ibandronic acid. One vial with 6 ml of a concentrate for solution for infusion contains 6 mg ibandronic acid (as sodium monohydrate).

The other ingredients are sodium chloride, glacial acetic acid, sodium acetate trihydrate and water for injections.

The following information is intended for healthcare professionals only

Dose: Prevention of skeletal events in patients with breast cancer and bone metastases

The recommended dose for prevention of skeletal events in patients with breast cancer and bone metastases is 6 mg intravenously given every 3-4 weeks. The dose should be infused over at least 15 minutes.

Patients with renal impairment

For patients with mild renal impairment (CLcr ≥50 and <80 mL/min) no dosage adjustment is necessary. For patients with moderate renal impairment (CLcr ≥30 and <50 mL/min) or severe renal impairment (CLcr <30 mL/min) being treated for the prevention of skeletal events in patients with breast cancer and metastatic bone disease the following dosing recommendations should be followed:

Creatinine Clearance

Dosage

Infusion Volume 1 and Time 2

(ml/min)

≥50 CLcr <80

6 mg

(6 ml of concentrate for

100 ml over 15 minutes

solution for infusion)

≥30 CLcr <50

4 mg

(4 ml of concentrate for

500 ml over 1 hour

solution for infusion)

<30

2 mg

(2 ml of concentrate for

500 ml over 1 hour

solution for infusion)

10.9% sodium chloride solution or 5% glucose solution

2Administration every 3 to 4 week

A 15 minute infusion time has not been studied in cancer patients with CLCr <50 mL/min.

Dose: Treatment of tumour-induced hypercalcaemia

Iasibon is usually administered in a hospital setting. The dose is determined by the doctor considering the following factors.

Prior to treatment with Iasibon the patient should be adequately rehydrated with 9 mg/ml (0.9%) sodium chloride. Consideration should be given to the severity of the hypercalcaemia as well as the tumour type. In most patients with severe hypercalcaemia (albumin-corrected serum calcium* ≥3 mmol/l or ≥12 mg/dl) 4 mg is an adequate single dosage. In patients with moderate hypercalcaemia (albumin- corrected serum calcium <3 mmol/l or <12 mg/dl) 2 mg is an effective dose. The highest dose used in clinical trials was 6 mg but this dose does not add any further benefit in terms of efficacy.

To convert the albumin-corrected serum calcium in mmol/l value to mg/dl, multiply by 4.

In most cases a raised serum calcium level can be reduced to the normal range within 7 days. The median time to relapse (re-increase of serum albumin-corrected serum calcium above 3 mmol/l) was 18- 19 days for the 2 mg and 4 mg doses. The median time to relapse was 26 days with a dose of 6 mg.

Method and route of administration

Iasibon concentrate for solution for infusion should be administered as an intravenous infusion.

In order to avoid potential incompatibilities Iasibon concentrate for solution for infusion should only be diluted with isotonic sodium chloride solution or 5% dextrose solution. Calcium containing solutions should not be mixed with Iasibon concentrate for solution for infusion.

Diluted solutions are for single use. Only clear solutions without particles should be used.

It is recommended that the product once diluted be used immediately (see point 5 of this leaflet ‘How to store Iasibon’).

Iasibon concentrate for solution for infusion should be administered as an intravenous infusion. Care must be taken not to administer Iasibon concentrate for solution for infusion via intra-arterial or paravenous administration, as this could lead to tissue damage.

Frequency of administration

For treatment of tumour induced hypercalcaemia, Iasibon concentrate for solution for infusion is generally given as a single infusion.

For the prevention of skeletal events in patients with breast cancer and bone metastases, the Iasibon infusion is repeated at 3-4 week intervals.

Duration of treatment

A limited number of patients (50 patients) have received a second infusion for hypercalcaemia. Repeated treatment may be considered in case of recurrent hypercalcaemia or insufficient efficacy.

For patients with breast cancer and bone metastases, Iasibon infusion should be administered every 3-4 weeks. In clinical trials, therapy has continued for up to 96 weeks.

Overdose

Up to now there is no experience of acute poisoning with Iasibon concentrate for solution for infusion. Since both the kidney and the liver were found to be target organs for toxicity in preclinical studies with high doses, kidney and liver function should be monitored.

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

Keep this leaflet. You may need to read it again.

If you have any further questions, ask your doctor or pharmacist.

This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4

What is in this leaflet:

1.What Iasibon is and what it is used for.

2.What you need to know before you take Iasibon.

3.How to take Iasibon.

4.Possible side effects.

5.How to store Iasibon.

6.Contents of the pack and other information

1. What Iasibon is and what it is used for

Iasibon contains the active substance ibandronic acid. This belongs to a group of medicines called bisphosphonates.

Iasibon is used in adults and prescribed to you if you have breast cancer that has spread to your bones (called ‘bone metastases’).

It helps to prevent your bones from breaking (fractures).

It also helps to prevent other bone problems that may need surgery or radiotherapy.

Ibandronate works by reducing the amount of calcium that is lost from your bones. This helps to stop your bones from getting weaker.

2. What you need to know before you take Iasibon

Do not take Iasibon

-if you are allergic to ibandronic acid or any of the other ingredients of this medicine that are listed in section 6

-if you have problems with your food pipe /gullet (oesophagus) such as narrowing or difficulty swallowing

-if you cannot stand or sit upright for at least one hour (60 minutes) at a time

-if you have or ever had low calcium in your blood.

Do not take this medicine if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Iasibon.

Warnings and precautions

Talk to your doctor or pharmacist before taking Iasibon:

if you are allergic to any other bisphosphonates

if you have any swallowing or digestion problems

if you have high or low blood levels of vitamin D or any other minerals

if you have kidney problems

if you are having dental treatment or surgery or know that you need some in the future, tell your dentist that you are being treated with Iasibon for cancer

Irritation, inflammation or ulceration of the gullet/food pipe (oesophagus) often with symptoms of severe pain in the chest, severe pain after swallowing food and/or drink, severe nausea, or vomiting may occur, especially if you do not drink a full glass of water and/or if you lie down within an hour of taking Iasibon. If you develop these symptoms, stop taking Iasibon and tell your doctor straight away (see sections 3 and 4).

Children and adolescents

Iasibon should not be used in children and adolescents below the age of 18 years.

Other medicines and Iasibon

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This is because Iasibon can affect the way some other medicines work. Also some other medicines can affect the way Iasibon works.

In particular, tell your doctor or pharmacist if you are taking any of the following medicines:

supplements containing calcium, magnesium, iron or aluminium

acetylsalicylic acid and non-steroidalanti-inflammatory medicines called “NSAIDs”, such as, ibuprofen or naproxen. This is because NSAIDs and Iasibon can both irritate your stomach and gut

a type of antibiotic injection called “aminoglycoside” such as gentamicin. This is because aminoglycosides and Iasibon can both lower the amount of calcium in your blood

Taking medicines that reduce stomach acid such as cimetidine and ranitidine, may slightly increase the effects of Iasibon.

Iasibon with food and drink

Do not take Iasibon with food or any other drinks except plain water as Iasibon is less effective if it is taken with food or drink (see section 3).

Take Iasibon at least 6 hours after you had last had anything to eat, drink or any other medicines or supplements (e.g. products containing calcium (milk), aluminium, magnesium and iron) except water. After taking your tablet, wait at least 30 minutes. Then you can have your first food and drink, and take any medicines or supplements (see section 3).

Pregnancy and breast feeding

Do not take Iasibon if you are pregnant, planning to get pregnant or if you are breast-feeding. Ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

You can drive and use machines as it’s expected that Iasibon has no or negligible effect on your ability to drive and use machines. Talk to your doctor first if you want to drive, use machine or tools.

Iasibon contains lactose.

If you have been told by your doctor that you cannot tolerate or digest some sugars (e.g. if you have a galactose intolerance, the Lapp lactase deficiency or have problems with glucose-galactose absorption), talk to your doctor before taking this medicine.

3.How to take Iasibon

Always take this medicine exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

Take your tablet at least 6 hours after you had last had anything to eat, drink or any other medicines or supplements except water. Water with a high concentration of calcium should not be used. If there is concern regarding potentially high levels of calcium in the tap water (hard water), it is advised to use bottled water with a low mineral content.

Your doctor may do regular blood tests while you are taking Iasibon. This is to check that you are being given the right amount of medicine.

Taking this medicine

It is important that you take Iasibon at the right time and in the right way. This is because it can cause irritation, inflammation or ulcers in your food pipe/gullet (oesophagus).

You can help stop this happening by doing the following:

Take your tablet as soon as you get up for the day before having your first food, drink, any medicine or supplements

Take your tablet with a full glass of water only (about 200 mL). Do not take your tablet with any drink other than water

Swallow the tablet whole. Do not chew, suck or crush the tablet. Do not let the tablet dissolve in your mouth

After taking your tablet, wait at least 30 minutes. Then you can have your first food and drink and and take any medicines or supplements

Stay upright (sitting or standing) position while taking your tablet and for the next hour (60 minutes). Otherwise, some of the medicine could leak back into your food pipe/gullet (oesophagus)

How much to take

The usual dose of Iasibon is one tablet each day. If you have moderate kidney problems, your doctor may reduce your dose to one tablet every other day. If you have severe kidney problems, your doctor may reduce your dose to one tablet each week.

If you take more Iasibon than you should

If you take too many tablets talk to a doctor or go to hospital straight away. Drink a full glass of milk before you go. Do not make yourself sick. Do not lie down.

If you forget to take Iasibon

Do not take a double dose to make up for a forgotten dose. If you are taking a tablet each day, skip the missed dose completely. Then carry on as usual the next day. If you are taking a tablet every other day or once a week, ask your doctor or pharmacist for advice.

If you stop taking Iasibon

Keep taking Iasibon for as long as your doctor tells you. This is because the medicine will only work if it is taken all the time.

If you have any further questions on the use of this medicines, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects although not everybody gets them.

Talk to a nurse or a doctor straight away if you notice any of the following serious side effects, you may need urgent medical treatment:

severe stomach pain. This could be a sign of an ulcer of the first section of the bowel (duodenum) that is bleeding, or that your stomach is inflamed (gastritis)

Rare (may affect up to 1 in 1,000 people)

persistent eye pain and inflammation

new pain, weakness or discomfort in your thigh, hip or groin. You may have early signs of a possible unusual fracture of the thigh bone

Very rare (may affect up to 1 in 10,000 people)

pain or sore in your mouth or jaw. You may have early signs of severe jaw problems (necrosis (dead bone tissue) in the jaw bone)

itching, swelling of your face, lips, tongue and throat, with difficulty breathing. You may be having a serious, potentially life threatening allergic reaction

severe adverse skin reactions

ear pain, discharge from the ear, and/or an ear infection. These could be signs of bone damage in the ear.

Not known (frequency cannot be estimated from the available data)

asthma attack

Other possible side effects

Common (may affect up to 1 in 10 people):

tummy pain, indigestion

low calcium levels in your blood

weakness

Uncommon (may affect less than 1 in 100 people):

chest pain

itching or tingling skin (paraesthesia)

flu-like symptoms, feeling generally unwell or in pain

dry mouth, strange taste in your mouth or difficulty swallowing

anaemia (bloodlessness)

high levels of urea or high levels of parathyroid hormone in your blood.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Iasibon

Keep this medicine out of the sightand reachof children

Do not use this medicine after the expiry date which is stated on the blister and carton after EXP. The expiry date refers to the last day of that month

Store in the original package in order to protect from moisture.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment